NEMT Credentialing Checklist: Every Document Brokers and Health Plans Ask For

Every broker and health plan checks your company, your owners, your insurance, your vans, and your drivers before it sends a single trip. This checklist puts every document in one place, with where to get it and when it expires. Work through it before you apply, and keep it current after you are approved.

How to use this template

1. Start with Part 1. The company items take the longest: the EIN letter, the NPI, and state Medicaid enrollment. Broker applications ask for all three.
2. Print one copy for each broker or plan. Their lists overlap, but each has its own limits and forms. Write the payer’s name at the top of Part 1.
3. Use one legal name and address everywhere. Match the IRS letter exactly on the NPI record, insurance, state filings, and bank account.
4. Scan every document into one folder. Name each file with the item and its expiration date.
5. Fill in every date column. Put renewals in Part 8, with a reminder 30 days before each one.
6. Send the file only when it is complete. Check each item against the broker’s own list first.

Your driver and vehicle files have their own checklists: the driver qualification file checklist and the vehicle inspection checklist. For the steps around the paperwork, see NEMT broker credentialing.

The template

Part 1: Company identity

Field	Entry
Broker or health plan this copy is for
Date started
Broker contact, name and phone

Item	Where to get it	Have it (yes or no)	Number or expiration
Legal name and any DBA, exactly as on IRS records	Formation papers and the IRS EIN letter
Articles of organization or incorporation	Your state’s Secretary of State
Certificate of good standing	Your state’s Secretary of State
IRS EIN letter (CP575 or Letter 147C)	IRS Business Tax Account, or call 800-829-4933
Signed Form W-9, March 2024 revision	irs.gov
Type 2 (organization) NPI and taxonomy code	NPPES, at nppes.cms.hhs.gov
State Medicaid provider ID	Your state Medicaid enrollment portal
State transportation permit or operating authority	Your state DOT, DMV, or utility commission
City or county business license and local permits	Your city or county
USDOT number and FMCSA operating authority, if FMCSA requires them for your trips across state lines	FMCSA
Counties served, days and hours, and vehicle count by type	You
Business start date and owner or manager contact	You
Small or minority business certification (optional)	Your state’s program

Part 2: Owners and managers

One row for each person with an ownership or control interest of 5 percent or more, each officer, director, or partner, and each managing employee.

Name	Role and ownership percent	Home address on file	Date of birth and SSN on file	OIG list search date	SAM.gov search date	State list search date	Criminal convictions to disclose

Part 3: Insurance

Coverage or form	Limit the contract requires	Your limit	Carrier and rating	Policy number	Expires	Broker named on it (yes or no)
Commercial general liability, per occurrence and aggregate
Commercial auto liability, combined single limit
Hired and non-owned auto
Workers’ compensation, or the state’s exemption letter
Umbrella or excess
Certificate of insurance with the broker as certificate holder
Additional insured endorsement
Notice of cancellation endorsement
Waiver of subrogation
Schedule listing every vehicle on the auto policy

Part 4: Vehicles

Unit	Year, make, model	VIN	Plate	Type and seats	Registration expires	Last inspection	Lift or ramp certified	Insurance card	Photos taken

Part 5: Drivers and attendants

Name	License number and expiration	Driving record date	Background check date	Drug test date	Exclusion search date	Training complete	Broker approval date

Part 6: Policies, training, and agreements

Item	Done (yes or no)	Date
Drug and alcohol policy (substance-free workplace)
HIPAA privacy policy and staff training
Fraud, waste, and abuse training for every employee, yearly
Business associate agreement with the broker
Complaint and incident reporting procedure
Emergency and bad weather plan
Driver orientation and training program
Compliance program certification, where the state requires one
Broker orientation or portal training

Part 7: Payment and trip setup

Item	Done (yes or no)	Notes
Direct deposit form and voided check
Signed provider agreement
Rate sheet signed with the agreement
Portal logins for the owner, dispatch, and billing
Driver app or vehicle tracking set up
Trip software connected to the broker, if you use one
Broker provider ID received

Part 8: Renewal tracker

Item	Expires	Reminder date	Uploaded to broker	Approved

What brokers and health plans ask for

Each broker keeps its own list. MTM Health’s is Appendix B of its provider agreement. These are the written lists from several brokers and one health plan, with their dates.

Broker or plan	Company and insurance	Vehicles	Drivers	Rule and date
MTM Health	Certificate of good standing on request. Liability of at least $500,000 general and $500,000 auto, with MTM as additional insured, notice of cancellation, and waiver of subrogation. Workers’ compensation or proof of exemption. Some states require more: Wisconsin asks for a $1 million combined single limit for general and auto liability, with MTM as certificate holder and additional insured.	State registration or inspection sticker, ADA compliance for wheelchair vehicles, and vehicle tracking	License, background check at hire and yearly, 3-year driving record yearly, drug tests, and training certificates	Standard agreement, January 1, 2023 version Pennsylvania posts; Wisconsin page, September 2026
MTM Health, Virginia	Business license, DMV intrastate authority, and FMCSA authority, each with its expiration date, plus any EMS permit and your NPI	Inspection and license dates, insurance expiration, plate and registration copies, and seats	Date of birth, SSN, training dates, license expiration, last background check, drug test, and record review	Provider handbook, approved August 10, 2026
Verida, Georgia	Business license and proof of liability insurance: an insurer rated A- or better, a general liability policy with what Verida lists as “$1 M SAM coverage with $2M aggregate”, and auto coverage for all owned, hired, and non-owned vehicles. Verida asks you to confirm the limits with its provider relations manager.	The vehicles on the auto policy, and a safety inspection by Verida	Driver credentials, background checks, and driving records, plus drug screens for all owners and drivers	Georgia provider page, September 2026
SafeRide Health	SafeRide as additional insured on the certificate, general liability of at least $1 million per occurrence and $2 million aggregate, and auto liability of at least $500,000	Registration and insurance	License, Social Security card, national background check, national sex offender registry check, driving record, pre-hire drug screen, and first aid, defensive driving, and securement training	Provider page, September 2026
MediTrans, Louisiana	Auto liability of at least $1 million per occurrence, general liability, and workers’ compensation or an approved waiver, with MediTrans as certificate holder	Registration, inspection report, insurance declaration page, inside and outside photos, and ADA papers if any	License, background check clearance, defensive driving and CPR or first aid certificates, and drug test results	Provider page, September 2026
CareOregon	Proof of insurance before the first ride, at each renewal, and at any change. Copies of all licenses and certifications.	Registration, a safety inspection by an ASE-certified mechanic within the last year, a yearly ADA check for wheelchair vans, and an insurance card or ACORD certificate	License of the right class, OIG exclusion check, criminal background check, and first aid and CPR before driving. Defensive driving and passenger safety courses within three months of hire, then every three years.	Transportation Provider Manual, version 1.3, February 2024

A few more rules shape the file. Verida has you submit its Request for Qualifications with driver and vehicle lists first, and asks for documents only if it needs providers in your area. MTM Health says its system will not assign trips to a provider whose credentials are not current. Modivcare says it visits providers in the field to confirm that vehicles meet contract standards (provider page, September 2026). For each broker’s full steps, see MTM Health, Verida, SafeRide Health, and Modivcare.

The federal screening behind every checklist

Every state Medicaid program has to check the same basics, and brokers pass those checks down to you.

• Driver minimum. Since section 209 of the Consolidated Appropriations Act, 2021, each state must make sure every NEMT provider and driver is not excluded from federal health programs and every driver has a valid license. Each provider must also have a process for state drug law violations and for reporting each driver’s driving history to the state (SMD 23-006, September 28, 2023).
• Broker oversight. A state broker program must make sure transport staff are “licensed, qualified, competent, and courteous” (42 CFR 440.170).
• Ownership disclosure. You disclose the name, address, date of birth, and SSN of each person with an ownership or control interest and each managing employee. It is due when you apply, when you sign the provider agreement, at revalidation, and within 35 days after an ownership change (42 CFR 455.104). An ownership or control interest means 5 percent or more, or being an officer, director, or partner.
• Criminal history. You disclose any owner, agent, or managing employee convicted of a Medicare or Medicaid crime (42 CFR 455.106). A 5 percent owner with such a conviction in the last 10 years generally means denial (42 CFR 455.416).
• Database checks. The state checks the Social Security Death Master File, NPPES, the OIG exclusion list, and the federal excluded parties list, now part of SAM.gov. It checks the exclusion lists at least monthly (42 CFR 455.436).
• Risk level. Moderate and high risk providers get site visits before and after enrollment. High risk adds a criminal background check and fingerprints from each 5 percent owner, due within 30 days of a request (42 CFR 455.450 and 455.434). CMS says states may raise transportation from limited to moderate or high risk.
• Application fee. CMS set the fee at $750 for applications filed in 2026. States collect it before signing a provider agreement, unless you are enrolled in, or already paid the fee to, Medicare or another state (42 CFR 455.460).
• Revalidation. The state revalidates every provider at least every 5 years (42 CFR 455.414).

Health plans add their own layer. Each Medicaid plan must follow a documented process for credentialing and recredentialing, and it may not contract with excluded providers (42 CFR 438.214). The state must screen and enroll every network provider of those plans. A plan may sign you while your enrollment is pending, but for no more than 120 days (42 CFR 438.602). See contracting with Medicaid health plans and how to become a Medicaid transportation provider.

State credentials brokers ask about

MTM Health’s 2025 letter of intent form, in use as of September 2026, asks for a state credential in many states. Have yours before you apply.

State	What MTM Health’s form asks for
Arizona	AHCCCS ID
California	Medi-Cal enrollment
Connecticut	DOT permit
Illinois	IMPACT ID
Kansas	KMAP ID
Maryland	Public Service Commission certificate
Michigan	CHAMPS ID
Minnesota	STS certification through MnDOT, the MnDOT number, and UMPI numbers for drivers
Nebraska	Public Service Commission certificate
North Carolina	NCTracks registration
Ohio	EMS license and ODM ID
Pennsylvania	Public Utility Commission certificate
Rhode Island	NEMT certificate
Virginia	State operating authority certificate
Washington, DC	WMATC certificate

The same form asks for your EIN, NPI, Medicaid ID, counties served, vehicle counts, and insurance limits. For what each state requires, see NEMT license requirements and our state guides.

Getting the company items

EIN letter. The IRS gives three ways to confirm an EIN: a business entity transcript, a digital CP575 notice in your Business Tax Account, or Letter 147C, which you request from its business and specialty tax line at 800-829-4933 (IRS page, updated July 17, 2026). New York Medicaid wants this letter with your FEIN and applicant name, and says a W-9 is not acceptable.

W-9. Brokers use it to report what they pay you. The current revision is dated March 2024. Sign it with the same name and EIN as the IRS letter.

NPI. Apply for a Type 2 NPI for the company in NPPES. The taxonomy codes for NEMT include 343900000X for non-emergency medical transport (van), 344600000X for taxi, and 347C00000X for private vehicle, in NUCC code set version 26.1. Update your NPPES record within 30 days of any change (45 CFR 162.410). See how to get an NPI number for NEMT.

Exclusion searches. Search every owner, manager, and driver on the OIG list and SAM.gov, and keep a saved copy of each result. The OIG online search takes up to five names at a time and can confirm a match with an SSN or EIN. OIG generally updates the list by the middle of each month. See the OIG exclusion list and keep an exclusion screening log.

State Medicaid enrollment. Apply in your state’s portal and expect the fee, the disclosures, and possibly a site visit. New York’s transportation enrollment (page updated May 2026) asks for the $750 fee, an EFT authorization, an ETIN certification, a prior conduct questionnaire if you answer yes to its questions, copies of your permits and licenses, the IRS letter, a signed attestation, and a letter of support from Medical Answering Services, which assigns New York Medicaid trips. That letter has been required for new applications submitted after April 15, 2024.

Keeping credentials current

Approval is not the end. Every credential has a date, and brokers act on it.

Rule	What happens	Rule and date
MTM Health, Rhode Island	Upload renewals at least 10 business days before expiration. Under 5 days, trips can come off the manifest on the expiration date.	Provider handbook, updated July 1, 2026
MTM Health, Virginia	Using a driver or vehicle with an expired credential costs 2 points for each expired credential, and trips by drivers with expired documents can go unpaid	Provider handbook, approved August 10, 2026
CareOregon	Missing papers or a lapse in insurance can stop new trips, and trips assigned for the uncovered time are removed	Transportation Provider Manual, February 2024
MediTrans, Louisiana	A provider out of compliance loses its standing orders, and trips resume only after a corrective action plan	Provider page, September 2026
Louisiana Medicaid	Send the broker the registration and certificate of insurance for each new vehicle before it is used	Manual chapter 10, issued July 14, 2025
Federal rule	Report ownership changes within 35 days and NPI changes within 30 days	42 CFR 455.104 and 45 CFR 162.410

Put every date from Parts 3 to 5 in Part 8, and review it each month. For the full recheck cycle, see NEMT recredentialing and reporting changes to Medicaid.

Why credentialing gets stuck

• Names that do not match. The IRS letter, NPI record, insurance, state filings, and bank account all need the same legal name.
• Certificates missing the broker. MTM Health and MediTrans want to be the certificate holder, and MTM Health and SafeRide Health want additional insured status too. Ask your agent for the broker’s exact wording. See certificate of insurance.
• Vehicles missing from the auto policy. MTM Health’s standard agreement says a scheduled auto policy must list every vehicle, and you must tell MTM right away about additions and removals.
• Unfinished applications. SafeRide Health restarts an application not completed within 30 days. New York deletes an enrollment application not submitted within 45 days of starting it.
• Owners left out. Every 5 percent owner must be disclosed and screened. A missing or false disclosure can end the enrollment.
• Applying where no one is needed. Verida and MediTrans first check whether your area needs providers. See how to get NEMT broker contracts for how to find the openings.